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Catheter Cardiovasc Interv. 2016 Jan 1;87(1):3-12. doi: 10.1002/ccd.25923. Epub 2015 Apr 2.

Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: A meta-analysis of randomized and observational studies.

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Institute of Cardiology and Center of Excellence on Aging, "G, d'Annunzio" University, Chieti, Italy.
Laboratory of Biostatistics, Department of Experimental and Clinical Science, "G, d'Annunzio" University, Chieti, Italy.



To test whether a strategy of complete revascularization (CR) as compared with incomplete myocardial revascularization (IR)-both performed with current "state-of-the-art" percutaneous coronary interventions (PCI) or coronary artery bypass graft (CABG)-would provide a clinical benefit in patients with multivessel coronary artery disease (MVCAD).


The "optimal" extent of myocardial revascularization remains to be determined.


We performed a meta-analysis of studies reporting on clinical outcomes of MVCAD patients treated with CR and IR, with extensive (>80%) use of stents for PCI or arterial conduits in CABG. Relative risk (RR) and 95% confidence intervals (CIs) for all-cause mortality were assessed as primary endpoint, myocardial infarction (MI) and repeat revascularization as secondary endpoints.


A total of 28 studies were identified, including 83,695 patients with 4.7 ± 4.3 years of follow-up. Compared with IR, CR was associated with reduced mortality (RR: 0.73; 95% CI 0.66-0.81) both after CABG (RR: 0.76; 95% CI 0.63-0.90) and PCI (RR: 0.73; 95% CI 0.64-0.82). The risks of MI (RR: 0.74; 95% CI 0.64-0.85) and repeat revascularization (RR: 0.77; 95% CI 0.66-0.88) were also lower after CR as compared with IR. Metaregression showed a significant RR reduction of MI associated with more recent publication (P = 0.021) and increasing prevalence of diabetes (P = 0.033).


In MVCAD, as compared with IR, CR confers a clinical benefit that seems larger in cohorts of patients enrolled in more recent studies and with a higher prevalence of diabetes. © 2015 Wiley Periodicals, Inc.


coronary artery bypass graft; coronary artery disease; percutaneous coronary intervention

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